僧帽弁狭窄症を合併した両側冠動脈肺動脈瘻の1例

A case of bilateral coronary artery-pulmonary artery fistulas associated with mitral valve stenosis

　僧帽弁狭窄症を合併した両側冠動脈肺動脈瘻の1例を報告する。症例は37歳女性。労作時息切れ，動悸を主訴に当科受診となった。心電図上洞性徐脈でST-T変化はなかった。しかし，運動負荷心電図では負荷6分で有意のST低下を認めた。心エコーではDDR　9mm／secで僧帽弁口面積は0.61cm²と減少していた。

　ドプラ心エコーでもpressure half timeは360 msecと延長していた。心臓カテーテル検査では，冠動脈造影にて右冠動脈および左冠動脈近位部より肺動脈へ向かう両側冠動脈肺動脈瘻が存在したが，他に狭窄，拡張等はなかった。肺／体血流比は1.09で，肺動脈でのO₂　step upは3％であった。僧帽弁交連切開術と同時に経肺動脈瘻孔部閉鎖を行ったが，術後冠動脈造影上瘻孔は認めず，運動負荷心電図でもST低下は認めなかった。

A case was reported of bilateral coronary artery-pulmonary artery fistulas associated with mitral valve stenosis. A thirty seven year old female was ad-mitted with the complaint of exertional dyspneaand palpitation, which had lasted for the 3 years precious to her admission to our hospital. Electro-cardiogram showed sinus bradycardia and no ST-T changes, but exercise ECG showed significant ST depression after 6 min of exercise. The DDR (9 mm/sec) and mitral valve area (0. 61 cm²) were showen by UCG examination to have decreased, and the pressure at half time (360 msec) was showen by Doppler UCG to be prolonged. On cardiac cathete-rization, coronary arteriography showed fistula from RCA to PA, and fistula from LCA to PA, but no occlusive lesions were demonstrated. P/S blood flow ratio was 1. 09, and 0₂ saturation was stepped up 3% in PA. She was operated on and given open mitral commissurotomy and closure of the fistula opening via the PA. After surgical repair, no abnormality was found by exercise ECG, and no fistulas were shown on coronary arteriography.